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Title: Exploring goals and goal-setting in chronic obstructive pulmonary disease (COPD): patient and physiotherapist perspectives
Author: Summers, Rachael Hannah
Awarding Body: St George's, University of London
Current Institution: St George's, University of London
Date of Award: 2013
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Background: Goal-setting is described as a 'cornerstone' of rehabilitation and patient-clinician collaboration is advocated. Chronic obstructive pulmonary disease is a condition commonly seen by respiratory physiotherapists. However, there is little research on the goals of patients with COPD or respiratory physiotherapist perspectives on goal-setting. Aim: To explore goals and goal-setting amongst patients and respiratory physiotherapists in the context of stable COPD. Methods: A qualitative approach was used, and a subtle realist, pragmatic approach adopted. Patients with COPD (n=13) and respiratory physiotherapists (n=17) were purposively selected to obtain a range of demographics. Semi-structured interviews were conducted, which were audio-recorded and transcribed. Thematic analysis was used, supported by constant comparison and negative case analysis. The researcher adopted a reflexive approach throughout. Findings: All patients described having goals. Goal definitions varied and consequently, not all patients recognised their pursuits as goals. Biopsychosocial factors capable of influencing goal pursuit were identified, and social circumstances and life events were significant. The physiotherapists identified difficulties in setting and reviewing goals collaboratively. Descriptions of goal-setting practice indicated considerable variation. The potential for professionally significant outcomes to be prioritised over patients' functional goals during goals review, was also identified. Key uncertainties related to: when the best time to set goals was, whether all patients had goals, and when goals should be reviewed. Barriers and facilitators included: environmental and person-specific factors. Conclusion: Patients with COPD may differ in their understanding and perception of goals. This may present a challenge to respiratory physiotherapists and other health professionals working with this group. In practice, collaborative goal-setting may be a subject of uncertainty amongst respiratory physiotherapists, particularly regarding when and how goal-setting should occur. Further research is needed to build knowledge in this under-researched area, and equip respiratory physiotherapists with the tools to collaborate with patients.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available